Statutory obligations on medical practitioners regarding child sexual abuse and protection
- Dignity 4Patients
- 30 minutes ago
- 5 min read
By Dee Duffy - The Medical Independent - 18.08.2025 -[IRELAND] - [Prevention]
Due to the high stakes involved in ensuring child protection and preventing harm to children, there are a number of mandatory requirements placed on healthcare professionals, who play a critical role in safeguarding the welfare of children.
All registered medical practitioners are mandated persons under ‘Children First’. Children First is a generic term used to encompass the Children First: National Guidance for the Protection and Welfare of Children 2017 (a national policy document to assist people in identifying and reporting child abuse) and the Children First Act 2015. (Medical practitioners:- include Surgeon, Doctor, Nurse, Midwife, Physiotherapist, Therapist, Dentist, Psychologist, Social Worker, Paramedic, Counsellor, Medical Technician)
Mandated persons
The current (ninth) edition of the Medical Council’s Guide to Professional Conduct and Ethics for Registered Medical Practitioners provides that practitioners must be aware of and comply with the national guidelines and legislation for the protection of children, and if they have reasonable grounds for suspecting that a child is being harmed, has been harmed, or is at risk of harm through sexual, physical, emotional abuse or neglect, they must report this to the appropriate authorities and/or the relevant agency without delay.
The Child and Family Agency (Tusla) is the dedicated State agency in Ireland responsible for improving wellbeing and outcomes for children. Medical Practitioners have two main legal obligations under the Act:
1. To report harm of children, above a defined threshold, to Tusla; and
2. To assist Tusla, if requested, in assessing a concern which has been the subject of a mandated report.
Mandated reporting
As mandated persons, Medical Practitioners are required to report any knowledge, belief or reasonable suspicion that a child has been harmed, is being harmed, or is at risk of being harmed. The Act defines harm as assault, ill-treatment, neglect, or sexual abuse, and covers single and multiple instances.
In determining whether a concern reaches the legal threshold to make a mandated report, a helpful question may be: Has the child’s health, development, or welfare been affected, is being affected or is likely to be affected by the harm?
If a Medical Practitioner is in any doubt as to whether the concerns reach the legal definition of harm for making a mandated report, they can contact Tusla, on a no-names basis, and seek further guidance.
Contact details for local Tusla social workers, including emergency/out-of-hours, should be available to doctors. At no stage should a child’s safety be compromised, and doctors should contact the gardaí without delay if they think a child is in immediate danger and they cannot contact Tusla.
HSE Child Protection and Welfare Reporting Policy 1
It is important to be familiar with the most up-to-date version of the above policy and any guidelines in place for a particular hospital. The HSE reporting procedure outlines key stages as: Recognising concerns, responding to any immediate safety needs, consulting with a line manager/senior staff member, reporting to Tusla, informing the family (unless there is good reason not to), recording, assisting Tusla where requested, and monitoring as to whether any further action is required.
Making a mandated report
The Act requires mandated persons to report a concern to Tusla “as soon as practicable”. All mandated reports can be submitted via www.tusla.ie and doctors should include as much information as possible. Mandated reports cannot be submitted anonymously. A report made in good faith detailing a reasonable concern about a child’s welfare will not amount to a breach of patient confidentiality and doctors will be protected from civil liability.
While there is no legal requirement for Medical Practitioners to inform the child’s parents/legal guardians that they intend to make a mandated report, the guidelines state that it is good practice to tell them and discuss the reasons. However, if by doing so, a Medical Practitioner believes the child will be placed at further risk or it would impair Tusla’s ability to carry out a risk assessment, or indeed that a Medical Practitioner will be placed at risk of harm, they should not inform them.
Recognising concerns
Medical Practitioners working in any specialty can come across child welfare concerns either through their own observations or through allegations reported to them. When treating adult patients, Medical Practitioners should consider the possibility of child welfare concerns in the context of parent/carer-related issues (eg, substance abuse, mental illness).
According to the HSE Child Protection and Welfare Policy, child neglect is the most frequently reported category of abuse, both in Ireland and internationally. Children may present with features of neglect such as malnourishment, lack of hygiene, etc, and sometimes, identifiers of neglect are only apparent over a period of time.
Medical Practitioners may observe signs of physical abuse such as non-accidental injuries, bruising, scarring, etc. Signs of emotional abuse may be more difficult to recognise as the signs are behavioural rather than physical and can be difficult to identify in once-off interactions.
Sexual abuse
It is important to remember that sexual activity involving a young person may be sexual abuse even if the young person concerned does not themselves recognise it as abusive.
Consensual sexual activity
There is one exception to reporting concerns of possible sexual abuse, which relates to certain consensual sexual activity between teenagers. In Ireland, the age of consent for sexual intercourse is 17, but where one of the parties to a sexual relationship is under 17, it may fall under the statutory reporting exception.
There is no reporting exception for sexual activity involving persons under 15 years; Medical Practitioners must make a mandated report to Tusla in those circumstances.
Consequences of non-reporting
While the Act does not impose criminal sanctions on mandated persons who fail to make a report to Tusla, if, following an investigation, it transpires that Medical Practitioners who do not make a mandated report and a child was subsequently left at risk or harmed, Tusla may:
▶ Make a complaint to the Medical Council;
▶ Pass information to the National Vetting Bureau of An Garda Síochána, which could be disclosed to a current or future employers when the doctor is next vetted.
Mandated assistance
Children First also provides that mandated persons can be requested by Tusla to provide necessary and proportionate assistance to aid their assessment of risk to a child, which usually involves a request for information (eg, a verbal/written report or to attend a case conference). Data protection legislation does not prevent the sharing of information on a reasonable and proportionate basis for the purpose of child protection.
Tusla has the authority to share information concerning a child with a mandated person and can only share what is necessary and proportionate. If a Medical Practitioner is required to share information with Tusla when assisting in the assessment of risk to a child, they are protected from civil liability. The Act makes it an offence, however, for a Medical Practitioner to disclose information shared with them by Tusla to a third party, unless they are provided with prior written authorisation from Tusla to do so.
Conclusion
Medical Practitioners play a key role in child protection and it is important to always bear in mind that the welfare of the child is paramount.
If a Medical Practitioner has any concerns relating to the health, development, or welfare of a child, they should report those concerns to Tusla without delay. Medical Practitioner should also contact their indemnifier for advice if they are unsure how to proceed. If you have been affected by any of the issues raised in this article and were abused in state run medical and health facilities, you can contact Dignity4Patients, whose helpline is open Monday to Thursday, 10am to 4pm.
Dignity4Patients Commentary: Medical practitioners also carry the responsibility of reporting colleagues if they suspect that a fellow practitioner is misusing their position of authority to exploit or harm children in their care. Failing to report such concerns, particularly where a child may be at risk, can have serious consequences for the practitioner’s professional reputation and future employability.